Liver and Gallbladder Flashcards
Condition wherein there is 80-90% liver parenchymal loss in patient without pre-existing liver disease; clinically presents with encephalopathy and coagulopathy; occurs <26 weeks post initial insult.
Acute liver failure
A clinical entity caused by severe loss of hepatoceullular function and shunting of blood from portal to systemic circulation, causing buildup of toxins that cause neuronal dysfunction (in acute cases); manifestations may range from subtle behavioral changes to deep coma and death.
Hepatic encephalopathy
Syndrome heralded by a drop in urine output and rising BUN and creatinine; appears in severe liver failure; characterized by renal failure in the setting of liver disease without primary renal abnormalities
Hepatorenal syndrome
Common causes of chronic liver failure.
Chronic HBV and HCV, Alcoholic liver disease, and NAFLD
Diffuse transformation of the liver into regenerating parenchymal nodules, surrounded by dense bands of scar, with variable degrees of vascular shunting.
Cirrhosis
Common causes of death in chronic liver failure.
Complications of acute liver failure and hepatocellular carcinoma
Increased resistance to portal blood flow that may be caused by prehepatic, intrahepatic and posthepatic causes; can cause dilation of the portocaval anastomoses and produce varices.
Portal hypertension
Severe arterial hypoxemia with dyspnea and cyanosis in patients with liver disease due to abnormal intrapulmonary vascular dilatation and increased pulmonary blood flow.
Hepatopulmonary syndrome
Pulmonary hypertension arising in liver disease and portal hypertension due to excessive pulmonary vascular remodeling; Clinically presents with exertional dyspnea and clubbing of the fingers.
Portopulmonary hypertension
Clinical entity that occurs when retention of bilirubin leads to serum levels of at least 2.0-2.5 mg/dL.
Jaundice
Most common cause of conjugated hyperbilirubinemia.
Hepatitis and intra- and extrahepatic obstruction of bile flow
Most common cause of unconjugated hyperbilirubinemia.
Hemolysis
The main differences in morphology of acute and chronic hepatitides.
Acute hepatitides have less inflammation and more hepatocyte death than chronic hepatitis
Which virus between HBV and HCV is more associated with hepatocellular carcinoma?
HCV (most cases of acute HBV infection present with subclinical disease and all of them recover)
Morphologic appearance of chronic Hepatitis B infection.
Ground glass hepatocytes
Morphologic appearance of chronic Hepatitis C infection.
Lymphoid follicles, bile duct injury and steatosis
Hepatitis characterized by early development of scarring after the initial wave of hepatocyte injury (versus viral hepatitides where scarring usually happens years after the initial insult); associated with confluent necrosis, marked inflammation, plasma cell infiltrate, and burned-out cirrhosis; has two types: Type 1 (in adults; associated with ANA and anti-SMA); and Type 2 (in children; associated ithe Anti-LKM1).
Autoimmune hepatitis
Most common drug causing ALF.
Acetaminophen
Most common substance causing CLF.
Alcohol
Amount of alcohol associated with development of ALD.
80 g/d
Liver enzyme pattern unique to ALD.
AST > ALT
Three morphological forms of alcoholic liver disease.
Hepatocellular steatosis; Alcoholic Steatohepatitis; and Steatofibrosis
Hepatocyte ballooning, eosinophilic intarcytoplasmic inclusion bodies composed of intermediate filaments (Mallory-Denk bodies) and neutrophilic infiltration are characteristic of:
Alcoholic Steatohepatitis
Most common metabolic liver disease; usually occurs in patients consuming <20 g/week of ethanol; associated with Type 2 DM, insulin resistance, dyslipidemia, and hypertension.
NAFLD
Most common outcome of NAFLD
Isolated fatty liver (>80%); most cases do not progress to NASH
Difference of non-alcoholic fatty liver disease from ALD.
Less prominent features of steatohepatitis compared to ALD
A rare disease characterized by microvesicular fatty change in the liver and encephalopathy; microscopy of hepatocellular mitochondria reveals pleomorphic enlargement and electron lucency of the matrices, with disruption of cristae and loss of dense bodies; clinically suspected in a pediatric patient who took Aspirin as antipyretic for a viral infection.
Reye syndrome
Triad of micronodular cirrhosis, diabetes mellitus and abnormal skin pigmentation; main pathology is extensive accumulation of body iron in the liver, pancreas and heart; most common form is autosomal recessive, involving mutations in HFE gene in Chromosome 6; associated with 200-fold increased risk of HCC.
Hereditary Hemochromatosis
Extensive accumulation of toxic levels of Copper in the liver, brain and eye; (Kayser-Fleischer rings); autosomal recessive; main pathology is loss of function mutations in ATP7B gene in Chromosome 13
Wilson disease (Hepatolenticular degeneration)
Autosomal recessive disorder characterized by panacinar emphysema and liver disease secondary to accumulation of misfolded proteins; histologically marked by PAS-positive, diastase-resistant, cytoplasmic inclusions, corresponding to mutant AAT; associated with increased risk of HCC.
_-1-antitrypsin deficiency
Most common cause of large bile duct obstruction in adults, and children, respectively.
Gallstones, biliary atresia
Secondary bacterial infection of biliary tree; clinically typified by Charcot triad: 1. fever, 2. jaundice, and 3. RUQ pain.
Ascending cholangitis
Intrehepatic gallstone formation (calcium bilirubinate) due to repeated bouts of ascending cholangitis and parenchymal destruction; associated with increased risk of cholangiocarcinoma.
Primary hepatolithiasis
Prolonged conjugated hyperbilirubinemia in the neonate; can either be caused by extrahepatic biliary atresia (can be corrected with surgery), or neonatal hepatitis (histologically characterized by multinucleated giant cells, and cannot be corrected, or even worsened with surgical intervention).
Neonatal cholestasis
Complete or partial obstruction of the lumen of the extrahepatic biliary tree within the first 3 months of life; single most common cause of death from liver disease in early childhood; most common is perinatal form; treatment of choice is Kasai procedure.
Extrahepatic biliary atresia
A chronic, progressive cholestatic liver disease characterized by nonsuppurative destruction of small to medium-sized intrahepatic bile ducts; associated with antimitochondrial antibodies is 90% of cases; histologically, characterized by destruction of interlobular bile ducts with lymphoplasmacytic infiltration with or without granulomas (florid duct lesions).
Primary biliary cirrhosis (PBC)
Chronic progressive fibrosis and destruction of extrahepatic and intrahepatic bile ducts of all sizes; patchy involvement gives rise to a beading appearance of ducts; histologically characterized by onion-skin lesion with an atrophic tubule on the center (small ducts) or acute on chronic inflammation (large ducts); associated with an increased risk of cholangiocarcinoma.
Primary sclerosing cholangitis (PSC)
Triad of choledochal cysts.
Pain, jaundice, abdominal mass
Choledochal cysts and fibropolycystic diseases predisposes to this particular kind of cancer.
Cholangiocarcinoma
Most common benign tumor of the liver.
Cavernous hemangioma
Most common liver tumor of early childhood.
Hepatoblastoma
A well-demarcated but poorly encapsulated lesion, consisting of hyperplastic hepatocyte nodules with a central fibrous scar; carries no risk for malignancy.
Focal nodular hyperplasia
A benign tumor characterized by hepatocytes without portal tracts with prominent neovascularization; harbors a risk for malignant transformation.
Hepatic adenoma
Type of hepatocellular adenoma with the highest risk of malignant transformation.
_-catenin adenomas
Most common primary malignant tumor of the liver; commonly arises in the setting of chronic liver disease; may appear as unifocal, multifocal or diffusely infiltrative; with strong propensity for vascular invasion; histologically, well-differentiated lesions may elaborate bile appearing as globules; tumor marker is AFP.
Hepatocellular carcinoma
Most common site of hematogenous metastases of HCC.
Lung
Most common tumor involving the liver.
Metastases
Most common type of gallstones; pale yellow in color; radiolucent.
Cholesterol stones (80%)
Pigment stones derived from sterile gallbladder bile; 50-70% are radiopaque.
Black pigment stones
Pigment stones derived from infected gallbladder bile; radiolucent.
Brown pigment stones
Complication of cholelithiasis, wherein a large stone erodes directly into adjacent small bowel.
Gallstone ileus (Bouveret syndrome)
Most common form of acute cholecystitis.
Acute calculous cholecystitis (90%)
The gallbladder may be contracted, of normal size, or enlarged; presence of stones in the absence of inflammation is diagnostic.
Chronic acalculous cholecystitis
Most common form of chronic cholecystitis; characterized by mononuclears in GB wall, with Rochitansky-Aschoff sinus.
Chronic calculous cholecystitis (>90%)
Most common malignant tumor of the biliary tract; maybe exophytic (with mass) or infiltrating (with thickening of the wall; more common); most frequent histology is adenocarcinoma.
Gallbladder carcinoma
Most important risk factor for the development of gallbladder carcinoma.
Gallstones
Second most common primary malignant tumor of the liver; malignant tumor of cholangiocytes; more common in extrahepatic bile ducts; may develop in the hilum (Klatskin tumor); risk factors include: NAFLD, PSC, fibrocystic diseases of the biliary tree (choledocal cysts), and infestation of Clonorchis sinensis and Opistorchis viverrini; most frequent histology is adenocarcinoma.
Cholangiocarcinoma
